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Category: Volume 05 Issue 12 December 2017
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Title: Proposed Diagnostic Scoring System to Predict Difficult Laparoscopic Cholecystectomy

Authors: Dr S.T.Bhondave, Dr Niranjan Dash, Dr Mrs.V.J. Thipse, Dr J.M. Gadekar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.67

Abstract

Background: One of the most common laparoscopic surgeries performed by the general surgeons all over the world is laparoscopic cholecystectomy (LC). Due to various intraoperative difficulties, it is important for a surgeon to evaluate it thoroughly pre-operatively.

Objective: To study the various risk factors and to predict the level of difficulty of laparoscopic cholecystectomy pre-operatively by the use of proposed scoring system.

Materials and Methods: 86 patients fulfilling the inclusion criteria undergoing LC were included in the study. The study was carried out at DVVPF’s Medical college and hospital, Ahmednagar between January 1, 2015, to December 1, 2017.Total maximum pre-operative score was 17 based on parameters as age, sex, BMI, prior attack of acute cholecystitis, palpable gall bladder(GB), abdominal scars, total leucocyte count (TLC) and certain ultrasonographic findings i.e. thickened gall bladder wall, distended or contracted gall bladder, pericholecystic fluid collection, impacted stone and altered hepatic echotexture. Score <5 was predicted as easy, 6-10 as difficult and 11-17 as very difficult. Intraoperative findings of LC were recorded and patients were categorized as easy, difficult and very difficult depending on various factors.

Results: Sensitivity and Specificity of the Dash, Bhondave & Gadekar scoring method was found to be 95.24% and 73.63% respectively and there were no cases with score above 10.  According to the Dash, Bhondave &  Gadekar scoring method, 76% cases were predicted to be easy out of which 70% turned out to be easy, while 24% cases were predicted to be difficult out of which 16% turned out to be difficult and 5% to be very difficult. Positive predictive value of this scoring method was 92% and 82% for easy and difficult cases respectively. Parameters like prior attack of acute cholecystitis (p<0.0002), palpable gall bladder (p<0.004) and ultrasonographic findings like thickened GB (p<0.00005), distended or contracted gall bladder (p<0.000001), pericholecystic fluid collection (p<0.0002) and impacted stone (p<0.003) were found to be statistically significant in predicting difficult LC.

Conclusion: Various scoring systems are available to predict difficult LC which are cumbersome to implement. We proposeDash, Bhondave&Gadekar scoring system which is easy and statistically reliable to predict difficult cases.

Keywords: Cholecystitis, Laparoscopic cholecystectomy, Parameters, Scoring system.

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Corresponding Author

Dr S.T.Bhondave

Postgraduate student, Department of General Surgery,

DVVPF’s Medical College and Hospital, Ahmednagar, Maharashtra, India